Healthcare Provider Details

I. General information

NPI: 1922154574
Provider Name (Legal Business Name): TAMMY JAYNE HUOTARI LMSW, CAAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ASHMUN ST
SAULT SAINTE MARIE MI
49783-1979
US

IV. Provider business mailing address

24260 W. GROSVENORS DR.
BRIMLEY MI
49715
US

V. Phone/Fax

Practice location:
  • Phone: 906-635-1390
  • Fax:
Mailing address:
  • Phone: 906-437-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082964
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: